The Upper Peninsula Surgery Center presents this information with the expectation that observance of these rights will contribute to a higher level of patient care & greater satisfaction for the patient & the patient’s healthcare providers. We have adopted the following lists of patient rights & responsibilities, which include, but are not limited to:

Patient Rights

• Patients have the right to be informed of their rights in a manner that they can understand and to exercise these rights without being subjected to discrimination or reprisal.
• Patients have the right to participate and make decisions regarding their care, treatment, and/or services.
• Patients are treated with respect, consideration, and dignity.
• Patients have the right to be free from all forms of abuse and harassment.
• Patients have the right to change their provider if other qualified providers are available.
  We follow the Health Insurance Portability and Accountability Act of 1996 (HIPPA). Under the HIPPA guidelines, patients are provided the appropriate privacy. Patients have the right to privacy of information given and services provided. Patients have the right to be informed of any person other than routine personnel that will be observing or participating in their treatment.
• Patients have the right to know the person or person’s responsible for coordinating their care and the credentials of these health care professionals.
• Patients have the right to the privacy and security of their individually identifiable health information. Personal disclosure and records are treated confidentially, and, except when required by law, patients are given the opportunity to approve or refuse their release.
• Patients are provided, to the degree known, complete information concerning their diagnosis, treatment, and prognosis. When it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient or to a legally authorized person or representative.
• Patients have the right to receive enough information from their physician so that they may understand the procedure or treatment being received in order to sign informed consent.
  Patients have the right to refuse treatment and to be informed of the consequences of their actions.
• Patients are given the opportunity to participate in the decisions involving their health care, except when such participation is contraindicated for medical reasons.
• Patients have the right to information regarding Advance Directives as required by state or federal law and regulations.
• Patients have the right to expect that care provided and services rendered are consistent with quality standards.
• Patients have the right to be informed of the mechanism for continued health care following discharge from the surgery center.
• Patients have the right to examine and receive an explanation of their statement of charges regardless of the source of payment.
• Patients have the right to know in advance the expected estimated amount of their charges and payment policies.
• Patients have the right to know the services available at the surgery center.
• Patients have the right to know provisions for after hours care and emergency care.
• Patients have the right to information concerning the institution to which they may be transferred should an emergency occur.
• Marketing or advertising regarding the competency and capabilities of the surgery center are not misleading.
• Patients have the right to be advised if the facility/physician proposes to engage in or perform human experimentation affecting their care of treatment. The patient has the right to refuse to participate in such research project(s).
• Patients’ Rights and Responsibilities were established with the expectation that observance of these rights will contribute to more effective patient care and greater satisfaction for the patient, family, physicians and the facility caring for the patient. Patients shall have these rights regardless of age, race, sex, national origin, religion, culture, personal values, preferences, and belief systems
• Patients have the right to know the method(s) for expressing grievances and suggestions to the surgery center.

Patient Responsibilities

• To read and understand all permits and/or consents you sign. If you do not understand your consent, it is your responsibility to ask the nurse or physician for clarification. If you do not understand the Financial Agreement, it is the patient’s responsibility to ask the Business Office Representative for clarification.
• To provide complete and accurate information to the best of their ability about their health, any medications, including over-the-counter products and dietary supplements and any allergies or sensitivities.
• To read carefully and follow any pre-operative written or oral instructions your physician or the surgery center has given and to notify your physician or the surgery center if you have not followed the pre-operative instructions.
• To inform their provider about any living will, medical power of attorney or other directive that could affect their care.
• To provide an adult to transport you home after the surgery if you have received medications and/or anesthesia.
• To provide for someone to be responsible for your care for the first 24 hours after your procedure.
• To carefully follow any written or verbal postoperative instructions from your physician(s) or nurse. This includes keeping any scheduled postoperative appointments with your physician or scheduled provider.
• To contact your physician regarding any post-operative questions, problems, or complications.
• To assure your financial obligations for services are fulfilled as promptly as possible and to assume ultimate responsibility for payment regardless of insurance coverage.
• To notify the Clinical Director or Medical Director if you feel any rights have been violated or if you have a complaint or suggestion for improvement. This can be accomplished by completing and returning your patient questionnaire or by directly contacting the Upper Peninsula Surgery Center.
• To be respectful of all the health care providers and staff, as well as other patients.

Concerns, Complaints, and Grievances

You may contact the following entities to express any concerns, complaints, or grievances you may have :

Upper Peninsula Surgery Center

Attn: Kay Holma, Clinical Director

1414 W. Fair Ave Suite #235

Marquette, MI 49855

(906) 273-2223

Michigan Department of Licensing and Regulatory Affairs

PO Box 30664

Lansing, MI 48909

1-800-882-6006

The Joint Commission

Office of Quality & Patient Safety

One Renaissance Boulevard

Oakbrook Terrace, IL 60181

www.jointcommission.org

Medicare Beneficiary Ombudsman

1-800-MEDICARE

www.cms.hhs.gov/center/ombudsman.asp

Civil Rights Complaints or Concerns:

U.S. Department of Health & Human Services

200 Independence Ave, SW, Room 509F

HHH Building

Washington, D.C. 20201

1-800-368-1019